Michelle George
Summary
Experienced Utilization Review Nurse with extensive expertise in clinical assessments and physician consultations. Proven ability to leverage InterQual and Milliman for effective decision-making while ensuring compliance with standards through meticulous chart auditing. Demonstrates strong communication skills and a keen aptitude for medical data gathering, analysis, and authorization procurement. Committed to enhancing patient care through efficient utilization review processes.
Overview
27
27
years of professional experience
1
1
Certification
Work History
Utilization Review Nurse
Molina Healthcare
12.2021 - 02.2025
- Assessed patient medical records to determine the appropriateness of requested services and procedures.
- Collaborated with multidisciplinary teams on developing strategies for improving care quality and controlling costs.
- Participated in multidisciplinary team meetings to discuss patient care issues and utilization review findings.
- Provided education to providers regarding utilization management processes and protocols.
Utilization Management Nurse
SPARC WELLNESS
03.2020 - 10.2022
- Performed daily utilization management reviews for inpatient hospitalizations to identify what level of care is medically necessary for reimbursement from different payors, i.e.
- Medicare, Medicaid, commercial insurances
- While ensuring health care is not compromised, but is most cost-effective.
Registered Nurse
Advocate Health Care
02.2019 - 10.2019
- Providing direct patient care as a Registered Nurse within the outpatient Interventional radiology/Cath/EP lab
Registered Nurse
Advocate Health Care
02.2016 - 01.2019
- Assistance Clinical operations manager in ICU
- Maintained staff schedules to ensure proper coverage for unit with a staff retention of +85% over 3 years during my tenure
- Ensured staff adequately trained to care for critical patients
- Provided leadership and guidance to nursing staff
- Assisted with the collaboration of nurses, physicians and residents to ensure best outcomes of ICU population
Registered Nurse
Advocate Health Care
06.1998 - 06.2016
- Performed daily functions of registered nurse and charge nurse in ICU
- Serviced patient population of critical care
- Counseled caregivers and families on end-of-life planning and educated on patient care options
- Charge Nurse to 24-bed ICU unit facilitated patient flow during emergency situations, admissions and transfers
- Managed central, arterial and PICC lines
- Maintained composure and efficiency when responding to rapid response situation and Code Blue calls
- Delivered quality care and comfort to patients with heart failure, pulmonary hypertension, pulmonary embolisms and end-stage renal disease
- Trained and mentored new RNs
Registered Nurse
Advocate Health Care
01.1998 - 01.2005
- Performed daily functions of registered nurse and charge nurse
- Serviced patient population of oncology, med-surgical, centralized telemetry
- Providing direct patient care this patient population
- Including patient teaching, initial and ongoing assessment
- Administering chemotherapeutic agents and monitoring for potential side effects
- As Charge nurse delegating appropriate task to registered nurses and nurse assistants according to staffing needs and patient acuity
- Also working alongside physicians, case managers and social workers to coordinate discharge plans
Education
Associate of Science - Nursing
South Suburban College of Cook County
06.1998
Skills
- Learning new concepts quickly
- Working well under pressure
- Communicating ideas effectively
- Excellent communication skills
- Proficient with computer programs
- Microsoft
- Excel
- Word
- InterQual
- Flexible with navigating change
- Navigating difficult situations
- Clinical assessment
- Physician consultations
- Milliman guidelines
Certification
- Basic Life Support Provider, American Heart Association 11/2024 - Current
- Registered Nursing License, State of Illinois Board of Nursing, 06/01/98 - Current
Activities
Organized a virtual mom’s brunch with family and friends during COVID pandemic to help support moms navigate the changes with virtual learning of their kids.
References
References available upon request.
Timeline
Utilization Review Nurse
Molina Healthcare
12.2021 - 02.2025
Utilization Management Nurse
SPARC WELLNESS
03.2020 - 10.2022
Registered Nurse
Advocate Health Care
02.2019 - 10.2019
Registered Nurse
Advocate Health Care
02.2016 - 01.2019
Registered Nurse
Advocate Health Care
06.1998 - 06.2016
Registered Nurse
Advocate Health Care
01.1998 - 01.2005
Associate of Science - Nursing
South Suburban College of Cook County
Similar Profiles
Mayra GarciaMayra Garcia
Claims Auditor at Bright Healthcare Plan & Molina Healthcare PlanClaims Auditor at Bright Healthcare Plan & Molina Healthcare Plan
Katrevia CarrKatrevia Carr
Healthcare Customer Service Representative at Molina HealthcareHealthcare Customer Service Representative at Molina Healthcare
Jenasi VelaJenasi Vela
Member Engagement Representative at Molina HealthcareMember Engagement Representative at Molina Healthcare
Reagan BisaillonReagan Bisaillon
Case Manager Supervisor at Molina HealthcareCase Manager Supervisor at Molina Healthcare
Michelle TallmadgeMichelle Tallmadge
TELEPHONIC NURSE CASE MANAGER/UTILIZATION REVIEW/MEDICAL AFFAIRS REVIEW NURSE at AIG DALLAS/HEALTH DIRECT INC.TELEPHONIC NURSE CASE MANAGER/UTILIZATION REVIEW/MEDICAL AFFAIRS REVIEW NURSE at AIG DALLAS/HEALTH DIRECT INC.